Out On The Couch

New Year, New You? Affirmative Therapy and New Year’s Resolutions

Posted: 1-23-24 | The Affirmative Couch

New Year’s Resolutions are one of the hallmarks of January—gyms are crowded, journals purchased, fresh fruits and veggies prepared, dating apps installed, and long-delayed medical appointments finally scheduled. What does this mean for therapy? 

Therapists can be inundated with new appointment requests and lapsed clients re-starting therapy, but they may also be wary of the [...]

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Holistic Psychology and Yoga with LGBQTIA+ Youth

Posted: 9-18-23 | Tayler Rose, MA

LGBTQIA+ youth have a higher susceptibility to developing mental health disorders than people not in this group, along with a higher rate of body dysmorphia and gender dysphoria (Huerta, 2019). Struggles with body image can complicate symptoms and treatment. These higher risks are related to discrimination and mistreatment at home and in society (Trevor Project, [...]

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Conflicts with Colleagues in Clinics and Group Practice Settings

Posted: 9-6-23 | The Affirmative Couch

We’ve written previously about how to handle conflict in therapy—but what about when you are experiencing conflict within your clinic, from a peer or supervisor? Conflicts with colleagues, particularly surrounding identity, can impact an entire community if left unresolved for too long. It can also affect the reputation of your practice, or leave you [...]

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Traumatic Invalidation and its Impact on LGBTQIA+ Clients

Posted: 8-21-23 | Rachel Jones

Traumatic invalidation carries significant implications for therapists working with LGBTQIA+ clients. It is crucial to understand what traumatic invalidation is, its discernible effects on LGBTQIA+ people, and how society contributes to an invalidating environment for historically marginalized communities. For mental health professionals, understanding and addressing traumatic invalidation within the context of working with LGBTQIA+ communities [...]

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Affirmative Psychoeducation for Autism Self-Diagnosis

Posted: 7-25-23 | Lauren Demshar Abbott

A Rise in Self-Diagnosis

Some DSM-trained clinicians may bristle when a patient identifies with a mental health diagnosis they have come to informally. In recent months, a common concern voiced in supervision and among mental health providers is the increase in patients and clients questioning if they embody characteristics of Autism.

Self-reflection is arguably a [...]

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Affirmation, Exploration, and Informed Consent

Posted: 7-18-23 | The Affirmative Couch

Gender Dysphoria disproportionately affects transgender and nonbinary (TGNB)  communities, and can impact mental health in many ways. For many TGNB individuals, affirmative therapists offer a space—perhaps the first space—to pursue therapy that accepts them for who they are. One of the key elements of affirmative therapy is combining affirmation with exploration, but always in the [...]

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5 Supervisor “Green Flags”

Posted: 6-22-23 | Rachel Jones

As an associate or pre-licensed therapist within the LGBTQIA+ community, you will find that identifying a clinical supervisor who is supportive of your unique needs and identities is essential for professional growth and wellbeing. The supervisory relationship plays a crucial role in shaping therapist development, client outcomes, and supervisee wellness (Burkard et al., 2009). To [...]

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6 Things For (Cis) Therapists to Know About Gender Euphoria

Posted: 6-8-23 | The Affirmative Couch

You’ve probably heard or read about gender dysphoria, but how much do you know about gender euphoria? Chances are good that you’ve talked about it with some of your clients. But if you’re relying on a few anecdotes or basic information, you may be missing out on the big picture. We want to share some [...]

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The Courage to Care for the Transitioning Self

Posted: 5-22-23 | Karina Schneidman

How It Begins

Any life transition is hard. The human condition is a complicated one at best. It is riddled with pain, sorrow, confusion, darkness, and the unknown. However, that also comes with the gift of growth, beauty, love, happiness, peace and of course courage to live the life each of us deserves. As these [...]

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5 Tips for Affirmative Therapists During Autism Acceptance Month

Posted: 4-12-23 | The Affirmative Couch

As you may know, April is Autism Acceptance Month. As knowledge of autism continues to grow and change with every year—and there are a greater number of adults who know that they are autistic—we wanted to highlight a few things that can help affirmative therapists work with their autistic clients.


Avoid Using Functioning Labels


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3 Trauma-Informed Alternatives to Positive Affirmations

Posted: 3-28-23 | The Affirmative Couch

Whether in therapy, in self-help books, or in broader discourse about mental wellness on social media, there is a lot of discussion about positive affirmations. In general, the idea behind positive affirmations is to “train” the brain to look for opportunity and growth rather than perseverating on failure and stagnation. But are positive affirmations for [...]

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Kink Affirmative Therapy: Perceptions of Power

Posted: 3-14-23 | Tayler Rose, MA

When practicing kink affirmative therapy, it is important as a clinician to understand the inherent dynamics that play into working with clients who are a part of the Bondage and Discipline, Dominance, and Submission, Sadism and Masochism (BDSM) community. Over 40 percent of the United States population has fantasies about or has engaged in BDSM [...]

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Gottman’s Four Horsemen in a Polyamorous Context

Posted: 3-1-23 | Stephanie Sullivan

The Four Horsemen of the Apocalypse is a metaphor originally put forth by Dr. John Gottman, a prevalent relationship researcher. Dr. Gottman used this description for four forms of negative communication patterns (criticism, contempt, defensiveness, and stonewalling) because they will often, and very effectively, end a relationship (Gottman & Silver, 2015). While this research was [...]

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5 Essential Self-Care Tips for Psychotherapists

Posted: 12-14-22 | Andrew Kravig

Being an affirmative psychotherapist is an important job. It’s easy to get caught up in caring for others and overlook your own well-being. While doing psychotherapy may be seen as “selfless,” it should never be “self-sacrificing.” For your sake, and for the sake of your clients, it is crucial to take a step back and [...]

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Managing Conflict in Affirmative Therapy

Posted: 12-7-22 | The Affirmative Couch

Relationships between therapists and clients can involve vulnerability. Exploring topics related to identity is delicate work.  Both client and therapist may be impacted by their education, knowledge, and preconceptions. Moreover, therapy often requires discomfort. None of this is news but: but managing conflict while centering your client’s experiences takes skill and experience.

Affirmative therapy requires [...]

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Supporting LGBTQIA+ Youth to Address Microaggressions

Posted: 11-22-22 | Tayler Rose, MA

Microaggressions are “everyday derogations, slights, and invalidations that are often delivered to people of minority or marginalized backgrounds” (Lui & Quezada, 2019). Daily microaggressions such as heterosexism (thinking heterosexual people are the norm and assuming everyone is heterosexual), assuming gender pronouns, or placing heterosexual norms about sexuality or relationships on an LGBTQIA+ person [...]

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Supporting Your ADHD Clients (and Colleagues)

Posted: 10-19-22 | The Affirmative Couch

October is ADHD Awareness Month—in contemporary media, ADHD is often presented as affecting mostly children, and more specifically  mostly young white boys (and we could do a whole separate blog about how cissexism, misogyny, and racism impact the diagnosis and treatment of ADHD).

ADHD continues into adulthood, and studies show that it [...]

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Substance Use Disorders in LGBTQIA+ Youth

Posted: 9-14-22 | Tayler Rose, MA

*Content warning: eating disorders, substance use disorders in LGBTQIA+ youth

LGBTQIA+ youth are more susceptible to developing a substance use disorder than people not in this group (Garcia et al., 2019). Affirming therapists must be cognizant that LGBTQIA+ clients are more likely to make impulsive decisions and have a high rate of dysphoria around body [...]

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Red & Green Flags of Emotional Safety

 Rainbow flags stand as one of the hallmarks of the LGBT community, symbolizing colorful celebrations of life, nature, sunlight, and spirit, amongst other positive notions (Gilbert Baker Foundation, n.d). However, as we consider emotional safety in queer relationships, it’s imperative that we recognize certain other “flags,” some of which dictate the need for increased boundaries, [...]

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How to make your practice more CNM affirmative

Posted: 8-10-22 | Andrew Kravig

As a young therapist intern, I once had a supervisor ask me what the difference was between “an open relationship and just screwin’ around.” I had to spend almost the full two hours of that group supervision meeting educating my supervisor and fellow interns about the nuances of consensual non-monogamy (CNM). I argued that  an [...]

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Eating Disorders with LGBTQIA+ Youth

Posted: 8-2-22 | Tayler Rose, MA

 *Content warning: eating disorders, sexual assault, aggressive behaviors

The intersection of eating disorders with LGBTQIA+ youth is a challenging presentation to treat. A therapist’s chief concern is that eating disorders have a higher mortality rate than any other mental health disorder (Edakubo & Fushimi, 2020). Secondly, people in the LGBTQIA+ community  have a high rate [...]

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